Physicians have always been concerned with psychiatric patients who find the "sick role" comfortable and thus difficult to give up. Past research on rates of remission usually centered on "medical" factors that might explain chronicity, for example, the patient's diagnosis, personality or the treatment received. These factors, specific to the individual, have never been strong enough to predict empirically which patients will remain sick. Recently it has become clear that the patient's family and the treatment system may have a part in such effects. The sociological theory of deviance called "social labeling theory" alerts us to the question asked in this study: What part does the patient's social experience with his family and the treatment system have in sustaining the sick role? We are investigating maintenance of the sick role at two levels. First we have predicted that the more comprehensive the structure of the psychiatric treatment system (e.g. the more integrated and extensive the after-system) and the more credence given to "intra-psychic" explanations of illness, the more likely that patients are maintained in the sick role. We are following discharged first-admission psychiatric patients from three hospital systems for one year after discharge to measure clinical symptoms and social performance outcome. Second, we predict that, depending upon relative power and beliefs about illness certain patient/treatment agent (and patient/family) negotiations serve to discourage the ex-patient from dropping the label of "mental illness" and returning to his normal role. We will measure the process of labeling and de-labeling by following the panel sample of patients through the first year after discharge, interviewing treatment people, patients and family at several points after discharge. The goal of this research is to construct an empirical causal model that will show how the ex-patient's social experience with family and treatment systems sustains the label of "illness" and, in turn, supports clinical symptoms.